Five Downsides Of Spacing Out Your Child’s Vaccines

It seems like the perfect compromise. You want to protect your child from illness, but you’re leery of vaccines. So you ask your pediatrician to “space them out” — to give no more than one or two per visit, or per month, or to skip a few for now.

You’re not refusing the couple of dozen shots recommended for the first two years of life, you’re just….delaying. And you have plenty of company: Parenting Websites teem with descriptions of the alternative vaccine schedules that mothers and fathers invent (examples here and here) or borrow from a popular book. So what could be bad?

Well, several things, say pediatricians and vaccine experts concerned about the widespread vaccine-spacing phenomenon. To begin with, they say, the premise that a simultaneous volley of shots could be too much for your child’s immune system needs to be put in context: Children’s immune systems are exposed to a constant barrage of foreign proteins, and vaccines are engineered to produce as focused an immune response as possible.

More broadly, here’s the big picture from Dr. Allison Kempe, a University of Colorado School of Medicine professor of pediatrics who researches popular resistance to vaccines:

“It’s a very small subset of parents who totally refuse vaccines,” she said, “but it’s an increasing number, and a much higher number, that are asking to space them out. And that results in the child being unprotected for longer periods of time. It may result in outbreaks of disease and it may mean that because the vaccines are spaced out, the child doesn’t actually end up getting all of them because it involves coming in for so many appointments.”

“The other thing is that I don’t know whether it’s a lot more traumatic for a child to constantly be coming in for a shot. All those things are unknown. And there’s absolutely no science behind it, that’s the biggest thing.”

Dr. Ben Kruskal, a vaccine expert and director of infection control at Harvard Vanguard Medical Associates, offers a similar view from the pediatric trenches. I’ve broken down his concerns here into five parts:

1) Prolonged Vulnerability

“The most potent reason why spacing is problematic is that the more you spread things out, the more time kids are vulnerable to infections they could be protected from,” he said. “The extra time of vulnerability you’re adding to a child’s life is really quite considerable, and that’s not a trivial thing.”

(Particularly because, as CDC vaccine-communication expert Glen Nowak points out, the diseases that vaccines can prevent are particularly dangerous when they occur in the youngest children.)

2) Potential Added Trauma and Fear

Under the standard CDC vaccine schedule, a child sometimes gets several shots at once. If those are spaced out, you have to bring the child in for more visits than the usual check-up schedule.

For very young children, Ben said, “I think the number of traumatic events is probably more relevant than the number of needles they get at one visit. I think having three or four visits with one needle apiece is probably more traumatic to a baby than having one visit with three or four needles. I’ve never seen data on this issue, but it’s a very strong impression that I, and the clinical staff I work with, all share.”

Particularly in children around 1 year old and up, he said, if they’re having one shot a week for several weeks, “By the third visit they tend to be really frightened, and it’s terrible for the parents and it’s terrible for the staff.”

Adds the CDC’s Glen Nowak: “Some research suggests that it’s really the first injection that causes the highest level of stress.” So “there may be an advantage to doing a bunch of shots at once.”

3) Contagion from extra visits

Each time you bring your child into the doctor’s office for those extra shots, there’s risk of various infections from the sick patients in the waiting room.

4) Potential Errors

The more “non-standard” a vaccination schedules is, the greater the likelihood of errors, Ben said. If a medical staff is not used to a child’s schedule, they might miss a vaccination or repeat it. Things “can go wrong,” he said, “though the good news is that extra doses are not harmful. But you’re hurting the child for no reason.”

5) When you make up your own schedule, it has no evidence base

Let me not mince words. I believe deeply in the power of parental instinct, and in parents’ rights to seek what they deem the best care for a child. But it seems to me that many people are pulling these alternative vaccine schedules out of, shall we say, their bottoms, with no strong scientific basis for the timing they choose. Is that so? I asked Ben.

He put it much better: “It’s as if you go to the mechanic and say, ‘You tell me the carburetor repair will take three days. Why don’t we have you do just one day, and then I’ll bring it back?’ There are all sorts of reasons why that may not work.”

The central source for the alternative schedules that many parents choose is “The Vaccine Book: Making The Right Decision For Your Child,” by “Dr. Bob” Sears, son of the pediatrician-guru Dr. William Sears. Published in 2007, it’s still at close to 1,000 on Amazon’s bestseller list, suggesting great popularity.

In fact, it’s so popular that Dr. Paul Offit, a leading national authority on vaccines, co-wrote a whole 2009 article challenging many of its arguments in the journal Pediatrics. Titled “The Problem With Dr. Bob’s Alternative Vaccine Schedule,” it’s here, and includes this criticism:

Sears often takes the position that, if parents think that a vaccine is problematic, then the vaccine is problematic. He believes that parents’ fears should be indulged by offering alternative schedules, not countered by scientific studies, and he fails to explain that good science is the only way to determine whether a vaccine causes a particular adverse event. Instead, Sears alludes to evidence on both sides of any issue, failing to distinguish studies on the basis of their quality, internal consistency, or reproducibility and failing to distinguish those that are accepted by the scientific community from those that are not.

Dr. Sears’s response in Pediatrics to Dr. Offit’s critiques is at the bottom of this page, including this passage:

I will admit that the book does offer one major controversial idea; my alternative vaccine schedule. However, it is important to note the context in which I offer that advice. At the end of the book, I encourage parents to vaccinate their children according to the CDC schedule if they feel confident in our nation’s vaccine system. For those parents who, after reading all the reasons why vaccines are important in my book, still believe vaccines aren’t safe and plan to not vaccinate, I at least ask them to consider getting the most important infant vaccines so their babies have protection from the life-threatening illnesses (HIB, PC, DTaP, and Rota).

Where my alternative schedule comes into play is for those parents who are still unsure about vaccines, but they do want to fully vaccinate. I offer them an optional schedule that gets their child fully vaccinated, but at a slower pace. It doesn’t delay any of the most important shots, but it slightly delays some shots that are for lower-risk diseases. This option is really for parents who would otherwise leave a doctor’s office unvaccinated, parents who are too torn to make a decision, and therefore often don’t make any decision to vaccinate at all.

My personal take: For my own children, I’m sticking with the CDC standard schedule, which, unlike the suggested schedules in The Vaccine Book, is backed by rafts of research that has found minimal risks outweighed by huge benefits. When they were babies, I was far, far more terrified of infectious disease than of possible side effects from vaccines. That’s still true.

The CDC’s Glen Nowak: “Our position is that parents should follow the recommended immunization schedule. It’s there for a reason. There’s a scientific basis for that schedule.”

Readers, what do you think? What guides your own decisions? Would you add any downsides — or upsides — of vaccine spacing?

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

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